Indian Journal of Surgery Medknow Publications on behalf of Association of Surgeons of India ISSN: 0972-2068 Vol. 64, Num. 6, 2002, pp. 523-524

Indian Journal of Surgery, Vol. 64, No. 6, Nov - Dec. 2002, pp. 523-524

Case Report

Renal Cell Carcinoma Metastasing to the Spermatic Cord

Sham L. Singla, Sombir S. Gahlyan, Yogender Singh Kadian, Narender Kaushik

Pt. B.D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana
Address for correspondence: Dr. Sham L. Singla , 321, Housing Board Colony, Rohtak-124001 Haryana

Paper received: June 2001
Paper accepted: January 2002

Code Number: is02010

Abstract

We report a case of renal cell carcinoma metastasing to the spermatic cord - a rarity and review the relevant literature on the subject.

Key words: Renal cell carcinoma, spermatic cord, metastasis

INTRODUCTION

Renal cell carcinoma (RCC) is known to metastasise to many organs. Metastasis from RCC to spermatic cord is rare with only 20 such cases having been reported till 1997.^1,2 We report another case of RCC metastasising to spermatic cord.

CASE REPORT

A 42-year-old man presented with a mildly painful nodule measuring lxl cm in the left spermatic cord that had been present for the 3 months. Patient had undergone a vasectomy 5 years ago and a left radical nephrectomy for RCC was done 18 months ago. General and abdominal examination were unremarkable. External genitalia were normal except for the cord nodule. Abdominal ultrasound and x-ray chest were normal. The nodule was excised under local anaesthesia. Histopathologically it was found to be adenocarcinoma of renal origin.

DISCUSSION

Malignant tumours of the spermatic cord are uncommon. Reported histopathological types of primary tumours include liposarcoma, fibrosarcoma, myxochondrosarcoma, leiomyosarcoma, mesenchymoma and fibrous histiocytoma.³ Along with testis⁴ or in isolation, the spermatic cord may be rarely involved by metastatic tumours from other organs like the stomach⁵, the urinary bladder⁶ or the lymphatic tissue.⁷ RCC is known to metastasise to spermatic cord and documented mode of spread is through retrograde flow to spermatic veins from the renal vein.^1,2

Fournier et al could find only 17 cases of metastatic RCC in the cord reported in the literature till 1995 and added two of their own.¹ In their 2 cases, metastases were detected 30 and 44 months after radical nephrectomy. In another case reported by Fallik et al, presence of metastasis into spermatic cord led to diagnosis of RCC in left side. This patient further developed metastasis to penis 5 years after radical nephrectomy.² In patients with RCC, during follow up, a careful examination of the external genitalia should be performed to exclude occult metastases.

Nodule in the cord following vasectomy is not uncommon. These nodules are generally sperm granuloma⁸ or chronic granuloma. If it is asymptomatic, one is likely to pass it as such and no surgery may be advised. Such nodules should be excised in patients who have been diagnosed to have malignancy especially of the kidney so that a secondary tumour is not missed.

REFERENCES

1. Fournier G, Chassagne S, Menut P, et al. Metastasis of renal adenocarcinoma to spermatic cord and the epididymus: 2 cases. Prog Urol 1995; 5:714-716.
2. Fallik ML, Long JP, Ucci A. Metachronous renal cell carcinoma metastasis to spermatic cord and penis. Scand J Urol Nephrol 1997; 31:299-300.
3. Jerome PR. Neoplasms of testis. In: Walsh PC, Retik AB, Vaughan ED et al, Ed. Campbell's Urology. 7th ed. Philadelphia: WB Saunders, 1998: 2411-2452.
4. Lauro S, Lanzetta G, Bria E, Trasatti L, et al. Contralateral solitary testis metastasis antedating renal cell carcinoma: a case report and review. Anti Cancer Res 1998; 18:4683-4684.
5. Kato K, Suzuki K, Sai S, Murase T, et al. A case of metastatic tumour of spermatic cord with hydrocele from gastric cancer. Hinyokika Kiyo 1999; 45:859-861.
6. Isa MM, Kabalin JN, Dietrick DD, et al. Spermatic cord metastasis from transitional cell carcinoma of the bladder. Urology 1994; 43:561-563.
7. Miller MB. NHL of spermatic cord. Acta Haematol 1994; 91:70-72.
8. Schmidt SS. Technics and complications of elective vasectomy. The role of spermatic granuloma in spontaneous recanalization. Fertil Steril 1966; 17:467.

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